Professor Alan Emond author of a new study claiming to overturn the link between autism and bowel disease has failed to disclose his conflict of interest as member of the UK’s Joint Committee on Vaccination and Immunisation [JCVI Members]. Emond’s paper omits mention of and fails to comment on a series of medical papers establishing the condition.

Archives of Disease in Childhood have since publication of Emond’s paper posted an eletter pointing out Professor Emond’s competing interest [Observations and concerns].

In 2006 after infant Georgie Fisher died following MMR vaccination it appears Professor Emond did not disclose JCVI membership tothe infant’s father and his wife when Emond was brought into the investigation by the coroner: [Georgie Boy MMR]. The Coroner subsequently discounted MMR as implicated in the death: [“MMR baby ‘chatting away’ hours before his death, inquest hears” – Lee Glendinning – The Guardian 2 December 2008]

Allegations of a failure to include a formal disclosure of interests of an appointment as a Court expert witness resulted in one of the authors of the 1998 Lancet study Dr Andrew Wakefield facing unprecedented investigation by the UK General Medical Council with a potential sanction of being struck from the UK’s medical register. Evidence before the GMC shows The Lancet knew specifically of Dr Wakefield’s appointment up to a year before the 1998 publication. A decision is not expected until the end of this year or early in 2010.

Emond’s non-disclosure comes at a time when confidence in medical journals is falling. Recent news includes blatant ‘fixing’ of the published scientific evidence base by drug industry interests: [Merck published fake journal – Bob Grant – The Scientist – 30th April 2009]. Drug maker Wyeth has also flooded medical journals with some 40 ghostwritten articles penned by prominent physicians who sold their name for cash, in an all-out effort to offset the scientific evidence linking its female hormone replacement drug, Prempro, to breast cancer: Judge orders Wyeth papers unsealed – Associated Press – July 25, 2009].

The Emond paper reviews medical data many years old for which no laboratory tests are available. Emond’s study uncovered a rate of 1 in 167 children with ASD born between April 1991 and December 1992, whereas the recently published study by Baron-Cohen detected a rate of 1 in 64 based on school data collected in the first half of the present decade: [Prevalence of autism-spectrum conditions: UK school-based population study Br J Psychiatry. 2009 Jun;194(6):500-9.].

Reuters news agency reported on Emond’s paper:

Autistic spectrum disorders are a group of developmental conditions that hinder people’s ability to communicate and build relationships. Previous studies, though inconclusive, “have described gastrointestinal symptoms in children with autism,” Dr. Alan Emonds, of the Center for Child and Adolescent Health, Bristol, and colleagues note in their study in the journal Archives of Disease in Childhood.

However, based on their results, “The bowel habits of young children with autistic spectrum disorder, in general, are no different from the rest of population,” Emond told Reuters Health. [Autism not tied to bowel movement patterns David Douglas – Reuters Thu Jul 23, 2009]

Editor Howard Bauchner of the Journal publishing Emond’s paper drives home the political message in an editorial:

The 1998 Wakefield paper in the Lancet ignited a worldwide concernthat there was a link between MMR vaccine and autism. Despiteno credible evidence that such an association exists, many groupsremain concerned that immunisations are somehow fuelling theincreasing prevalence of autism.

The UK is just now recoveringfrom the impact of the Lancet paper on MMR immunization rates.Unfortunately, it appears that many of the concerns raised byparents in the UK have crossed the pond and are affecting immunisationrates (and schedule) in the US.Drs Sandhu, Steer, Goldingand Emond, from the University of Bristol report that duringthe first 42 months of life, children with autistic spectrumdisorder have a similar stool pattern to other children. Althoughthere was a slight increase in stool frequency between 30 and42 months of age they conclude: “There were no symptoms to supportthe hypothesis that ASD children had enterocolitis.” [Atoms: Autism and primary gastrointestinal pathology Howard Bauchner, Editor-in-Chief Archives of Disease in Childhood 2009;94:i]

The summary conclusion of Emond’s new study states:

During the first 42 months of life, ASD children had a stoolpattern that was very similar to that of other children, apartfrom a slight increase in stool frequency at 30 and 42 months.There were no symptoms to support the hypothesis that ASD childrenhad enterocolitis.

There has been considerable debate following publication ofa Lancet paper in 1998 describing 12 children with lymphoidhyperplasia, non-specific colitis and pervasive developmentaldisorder of sudden onset. Wakefield and colleaguessuggestedthat a primary gastrointestinal pathology, an enterocolitiswhich they described as a new variant of inflammatory boweldisease, plays an important role in the onset and clinical expressionof autism. [The early stool patterns of children with autistic spectrum disorder Archives of Disease in Childhood 2009;94:497-500].

The claim to have found a new inflammatory bowel disease published in the 1998 Lancet paper as ‘consistent gastrointestinal findings’ involving ‘nonspecific colitis’ were supported first by a series of peer reviewed papers including in The Lancet itself:-

Balzola, F., et al., “Panenteric IBD-like disease in a patient with regressive autism shown for the first time by wireless capsule enteroscopy: Another piece in the jig-saw of the gut-brain syndrome?” American Journal of Gastroenterology, 2005. 100(4): p. 979- 981.

WHAT YOU CAN DO

If you are concerned write to your political representative. Don’t complain when politicians do nothing if you do not write and keep on writing. It is their job to represent you. All our kids deserve proper science to protect their safety.